Red flags for colorectal cancer that warrant screenings before 45 years of age

Colorectal cancer (CRC) is now the leading cause of cancer death in adults under 50 and the second leading cause of cancer death in the U.S., highlighting the importance of routine screenings.

Adults 65 and younger comprise nearly half (45%) of all new cases — a significant increase from 27% in 1995, according to a report from the American Cancer Society.

"Once considered a disease that primarily affected people over 50, we are now seeing increasing diagnoses in patients in their 20s, 30s and 40s — making it even more important not to dismiss symptoms based on age alone," Dr. Timothy Cannon, director of the Molecular Tumor Board and co-director of the Gastrointestinal Cancer Program at Inova in Virginia, told Fox News Digital.

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Official health agencies recommend that CRC screenings start at age 45 and continue through age 75 for adults at "average risk."

Stool-based tests can be used to detect blood or DNA changes, potential indicators of cancer. Depending on the type of stool test, it can be performed every one to three years.

A colonoscopy is a medical procedure that allows a doctor to examine the inside of the patient’s colon and rectum using a thin, flexible tube with a camera on the end. For average-risk adults, a colonoscopy is typically done every 10 years.

"Colonoscopy remains the gold standard because it not only detects cancer early, but can also prevent it by identifying and removing precancerous polyps," Cannon said.

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Dr. Michael Martin, a California physician, emphasized that colonoscopy is generally preferred for younger patients who are clearly at higher risk. 

"Stool-based tests are appropriate screening options for average-risk adults, but they are not the best choice for people with significant family history, inflammatory bowel disease, hereditary syndromes or alarm symptoms," he told Fox News Digital. "If symptoms are present, the goal is not screening but diagnosis, and colonoscopy is usually the more appropriate test."

Doctors may suggest earlier screenings for people who fall into the following higher-risk groups.

"A family history can make screening earlier and more frequent," Martin told Fox News Digital.

The American College of Gastroenterology recommends early screening if one first-degree relative is diagnosed with colorectal cancer or an advanced polyp before age 60, or if two first-degree relatives are diagnosed at any age.

"They should generally start colonoscopy at age 40 or 10 years before the youngest affected relative’s diagnosis, whichever comes first," Martin said. "In that setting, repeat the colonoscopy every five years is then generally recommended."

Cannon listed the following red flags that warrant earlier screenings.

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"While many of these symptoms can be caused by less serious conditions, they should never be ignored," he said.

Rectal bleeding in particular should always be taken seriously, even in younger patients, Cannon said. 

"Too often, symptoms are attributed to hemorrhoids, diet, stress or athletic activity without further evaluation," he noted. "Any persistent or unexplained bleeding warrants a conversation with a physician, and in some cases, a colonoscopy."

Some common hereditary syndromes increase the risk of colorectal cancer and may warrant earlier screenings.

For example, people with Lynch syndrome — an inherited DNA mutation that greatly increases lifetime risk — should get a colonoscopy every one to two years starting at about 20-25 years old or two to five years before the youngest diagnosed family case, according to the National Cancer Institute.

Familial Adenomatous Polyposis (FAP), another genetic variant, carries the risk of thousands of polyps and a nearly 100% lifetime risk of CRC, noted the American Cancer Society. Those with FAP are advised to start annual screenings at as early as 10 to 12 years old.

Several other syndromes and genetic variations — including Peutz–Jeghers Syndrome, Juvenile Polyposis Syndrome and MUTYH-Associated Polyposis (MAP) — can also warrant earlier screenings.

Those with inflammatory bowel disease (IBD), including ulcerative colitis and Crohn’s disease, face a higher lifetime risk of developing colorectal cancer, according to the Centers for Disease Control and Prevention.

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This is largely due to chronic inflammation that causes cellular changes. In this case, the patient may be advised to start colonoscopy screenings before age 45.

If someone falls into a category that warrants an early screening before 45, and then the screening is normal, the length of time until the next one will depend on the specific risk factors, according to Martin.

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"If it was performed because of a strong family history, repeating it every five years is common," he advised. "If the person turns out not to have colon cancer (or an advanced polyp) and is closer to average risk than to high risk, the interval may be longer." 

In many cases, early screenings will be covered by insurance, Martin said, but coverage rules can differ depending on whether the exam is classified as screening or diagnostic.

"Under federal law, recommended screening tests for average-risk patients are generally covered without cost-sharing, but a colonoscopy done because of symptoms is often considered diagnostic, as mentioned above," he noted. "This can have an impact on deductibles or co-pays. The exact out-of-pocket cost varies by insurer and plan."

The encouraging news is that colorectal cancer is often preventable, Cannon emphasized.

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"Most cancers develop slowly from precancerous polyps over many years," he said. "Screening allows physicians to detect and remove these polyps before they turn into cancer."

"The key message: If something feels new, persistent, or concerning, don’t wait. Early evaluation can save your life."